Quality of life and colorectal cancer: a review

Quality of Life in Cancer Patients: The Modern Psycho-Oncologic Approach for Romania-A Review

Quality of life (QOL) is an important indicator of human satisfaction and well-being. QOL is significantly and persistently affected for patients after a cancer diagnosis. Despite some evidence suggesting that psycho-oncologic interventions can provide lasting benefits, the inclusion of such interventions in cancer therapy is not universal. This article provides an overview of the known approaches to the evaluation of QOL in cancer patients and various interventions for improving patients' outcomes, with a focus on the eastern European regional and specific Romanian context. With a mortality rate above and cancer care performance below the EU average and unequally distributed, Romania urgently needs a national coordination program, which is discussed in our review, highlighting the main psychological tools needed for the assessment and the challenges involved in implementing the program. In the end, we suggest some directions for the future development of the psycho-oncologic approach in the context of social considerations, policy, and the unexpected financial challenges the nation provides.

Quality of Life in Patients With Severe Skin Reactions in Course of First-Generation Epidermal Growth Factor Receptor Inhibitors Monoclonal Antibodies (Our Experience With Cetuximab)

Background

Metastatic colorectal cancer (mCRC) with wild type expression of RAS and RAF genes can be treated with anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, such as cetuximab, in combination with chemotherapy. Skin toxicity represents the most serious and frequent side effect in these patients. Skin manifestations occur in approximately 80% of patients. In this study, we investigated the consequences on body image and quality of life (QoL) of patients with severe skin toxicity.

Methods

One hundred patients were enrolled with mCRC. All patients signed informed consent and completed questionnaires to assess QoL and body discomfort. Toxicity was assessed on Common Terminology Criteria for Adverse Events (CTCAEs).

Results

The greatest impact on QoL was represented by difficulties in managing skin rash-related side effects. Data showed a significant impact in psychological sphere and social relationships.

Conclusions

Skin side effects, particularly rash, influence QoL and social relationships, compromising therapeutic compliance.

Personality (at Intrapsychic and Interpersonal Level) Associated With Quality of Life in Patients With Cancer (Lung and Colon)

The objective of this study was to determine the association of quality of life (QoL) and intrapsychic and interpersonal behaviors (Structural Analysis of Social Behavior [SASB]) of patients with cancer (lung: n = 88; age 62.8 ± 10.1; colon: n = 56; age 60.1 ± 11.4). Personality described by SASB clusters (Cls): SASB-Questionnaire; QoL tests: FACT_G and QLQ-C30. Patients with lung cancer (n = 88; age 62.8 ± 10.1) and colon cancer (n = 56; age 60.1 ± 11.4; all stages of severity). Multiple regression analyses. Multiple linear regression: dependent variable: FACT_G; covariates: physical functioning, cognitive functioning, SASB-Cl3-50°, SASB-Cl6-50°. Analysis of variance and t test confirm validity of the model (P < .001). SASB-Cl3 with FACT_G (P = .034); SASB-Cl6 with FACT_G (P = .002); age with FACT_G (P = .018); physical functioning with FACT_G (P < .001); cognitive functioning with FACT_G (P < .001). Personality traits such as self-critical and oppressive behaviors, low capacity for self-esteem, physical and cognitive functioning, and age (a higher age determines a better QoL) strongly determine QoL in patients with lung and colon cancer. This may suggest areas of therapeutic intervention.

Health-related quality of life in long-term survivors of colorectal cancer and its association with all-cause mortality: a German cohort study

Background

The group of colorectal cancer (CRC) survivors continues to grow worldwide. Understanding health-related quality of life (HRQOL) determinants and consequences of HRQOL impairments in long-term CRC survivors may help to individualize survivorship care plans. We aimed to i) examine the HRQOL status of CRC long-term survivors, ii) identify cross-sectional sociodemographic and clinical correlates of HRQOL, and iii) investigate the prospective association of HRQOL after CRC diagnosis with all-cause mortality.

Methods

We assessed HRQOL within a Northern German cohort of 1294 CRC survivors at a median of 6 years after CRC diagnosis using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Cross-sectional correlates of different HRQOL dimensions were analyzed using multivariable-adjusted logistic regression models with HRQOL as a binary variable. With multivariable-adjusted Cox proportional hazards regression models, hazard ratios (HR) of all-cause mortality were estimated per 10-point-increments of an HRQOL summary score, a global quality of life scale, and HRQOL functioning and symptom domains.

Results

The median HRQOL summary score was 87 (interquartile range: 75–94). Sex, age, education, tumor location, metastases, other cancers, type of therapy, and current stoma were identified as correlates of different HRQOL scales. After a median follow-up time of 7 years after HRQOL assessment, 175 participants had died. Nearly all HRQOL domains, except for cognitive functioning and diarrhea, were significantly associated with all-cause mortality. A 10-point-increment in the summary score decreased the risk of death by 24% (HR: 0.76; 95% CI: 0.70–0.82).

Conclusions

HRQOL in CRC survivors appeared to be relatively high in the long term. Various clinical and sociodemographic factors were cross-sectionally associated with HRQOL in long-term CRC survivors. Lower HRQOL was associated with increased all-cause mortality. Individualized healthcare programs for CRC survivors (including psychosocial screening and interventions) are needed to detect decreased HRQOL and to further improve long-term HRQOL and survival.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5075-1) contains supplementary material, which is available to authorized users.

Sphincter-saving proctectomy for rectal cancer with NO COIL® transanal tube and without ostoma. Clinical outcomes, cost effectiveness and quality of life in the elderly

BACKGROUND

Colorectal cancer is one of the most common invasive cancers, and it is responsible for considerable physical and psychosocial morbidity specially in older patients. However, only few reports focused on quality of life, cost-effectiveness and clinical outcomes of rectal cancer patients undergone to surgery. This retrospective study compares short-term and long-term outcomes in rectal cancer patients with more and less than 75 years of age.

METHODS

Four hundred consecutive patients underwent radical surgery for rectal adenocarcinoma and they were collected in a prospective institutional database and divided into two groups: group 1 (≥75 years, N.=98); group 2 (<75 years, N.=302). Rectal anterior resection (RAR) with sphincter-saving restorative proctectomy and with application of silicone transanal tube NO COIL® 60-80 mm long, was the only procedure considered. Main clinical and pathological data were assessed and compared.

RESULTS

Statistically significant differences between the two groups were detected regard to comorbidities and the emergency presentation. Overall survival is lower in patients over 75 age, but cancer-related survival is not different between the two groups.

CONCLUSIONS

Although advanced age is associated with higher morbidity and mortality, in our experience, itself is not a contraindication for surgical sphincter-saving proctetomy in rectal cancer patients. The absence of a stoma also improved the cost effectiveness and patients' quality of life in both groups: psychological morbidity, sexuality, levels of anxiety and depression, body image.

Financial Impact of Colorectal Cancer and Its Consequences: Associations Between Cancer-Related Financial Stress and Strain and Health-Related Quality of Life

BACKGROUND

The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer.

OBJECTIVE

We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors.

DESIGN

This was a cross-sectional postal survey.

SETTINGS

The study was conducted in Ireland, which has a mixed public-private healthcare system.

PATIENTS

Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry.

MAIN OUTCOME MEASURES

Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50).

RESULTS

A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22).

LIMITATIONS

Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life.

CONCLUSIONS

Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract http://links.lww.com/DCR/A447.

Quality of Life and Characteristics of Colostomy Patients

Introduction: Colostomy imposed multiple impacts on the patient’s life including physical, psychological, social, and spiritual. This study aims to identify the level of quality of life as well as to examine the differences of quality of life among colostomy patients with regards to certain demographic characteristics.Methods: This study used a cross-sectional and descriptive analytical approach. Seventy-one colostomy patients were recruited purposively to participate in the study. The studied variables included quality of life and demographic characteristics. The data was collected by using the WHO Quality of Life – BREF instrument. One-way ANOVA and an independent t-test were employed to analyse the differences in quality of life with regards to certain demographic characteristics.Results: The study found that the majority of subjects perceived that their level of quality of life ranged between very low to moderate (77.4%). Satisfaction with support from friends was rated as the highest item of quality of life, whereas satisfaction with sexual relationships was rated as the lowest item of quality of life. There was no significant difference in the patients’ quality of life with regards to age group, educational background, occupation, length of being ostomate, sex, and other health problems.Conclusions: The study implied that nurses need to realise and pay attention to multiple aspects of stoma patient’s quality of life. Nursing care should not merely focus on stoma care but also holistically consider on meeting sexual needs, as well as the psychological, social, and spiritual needs of the patients.

The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review

BACKGROUND

Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients.

OBJECTIVES

To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Colorectal cancer survivors aged 18 years and over.

TYPES OF INTERVENTIONS

Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy.

TYPES OF STUDIES

Pre- and post-observational and experimental studies.

OUTCOMES

Physical activity, ability to perform activities of daily living (functional status) and QoL.

SEARCH STRATEGY

CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015.

METHODOLOGICAL QUALITY

All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

DATA EXTRACTION

Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software.

DATA SYNTHESIS

The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form.

RESULTS

A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies.

CONCLUSION

In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment.

IMPLICATIONS FOR PRACTICE

The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors.

IMPLICATIONS FOR RESEARCH

The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.

Impact of colorectal cancer diagnosis and treatment on health-related quality of life among older Americans: a population-based, case-control study

BACKGROUND

Data on health-related quality of life (HRQoL) changes among Americans aged ≥65 following colorectal cancer (CRC) diagnosis and treatment are limited. This study compared HRQoL changes among CRC patients across stages from before to after diagnosis with matched noncancer controls.

METHODS

This population-based study used the Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (MHOS) data set (1998-2007). Medicare Advantage beneficiaries diagnosed with CRC between their baseline and follow-up MHOS (n = 349) were matched to noncancer controls (n = 1745) using propensity scores. Mixed-effects analysis of covariance models estimated changes in HRQoL (measured by the Medical Outcomes Study Short Form-36/Veterans RAND 12-item Survey) and the ability to perform 6 activities of daily living (ADLs) between baseline and follow-up. Logistic regression models estimated odds ratios for ADL impairments and major depressive disorder (MDD) risk.

RESULTS

Mean time between CRC diagnosis and follow-up MHOS was 12.3 ± 9.8 months. Compared with controls, CRC patients had significantly lower scores in all physical and mental health domains at follow-up. The greatest decrements were observed in physical health and were largely driven by declines in the 6 months postdiagnosis and in stage III and IV patients. At follow-up, CRC patients had greater overall ADL impairment and difficulty with dressing, eating, and getting in/out of chairs. CRC patients, particularly stage IV patients, had greater odds of being at risk for MDD relative to controls.

CONCLUSIONS

This study further underscores the adverse effects of CRC on physical health and the need to support older Americans' basic self-care needs, with attention to later-stage patients' increased debility.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer

OBJECTIVE

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.

Psychosocial predictors of health outcomes in colorectal cancer: a comprehensive review

BACKGROUND

A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients.

METHODS

We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles.

RESULTS

Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival.

CONCLUSIONS

The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).

Quality of life after surgery for rectal cancer

Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.

Sexual function, incontinence, and wellbeing in women after rectal cancer--a review of the evidence

INTRODUCTION

Colorectal cancer (CRC) is the second most common cancer. One-third of these cancers occur in the rectum. Treatment of rectal cancer involves surgery with/without radiotherapy and chemotherapy. Surgery is undertaken to prevent damage to the nerves controlling bladder, bowel, and sexual organs, whether this translates into preservation of urinary and fecal continence and sexual function and, ultimately, quality of life (QoL) is not known.

AIM

The aim of this review was to summarize the literature regarding the impact of treatment for rectal cancer on bladder and bowel continence, sexual function and QoL in women.

MAIN OUTCOME MEASURES

A comprehensive review of the current literature on sexual function, incontinence and wellbeing in women after treatment for rectal cancer highlighting prevalence rates, trial design, and patient population.

METHODS

We conducted a systematic search of the literature using A systematic search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2011) for English-language studies that included the following search terms: "colorectal cancer," or "rectal cancer," or "rectal neoplasm," and "sexual function," or "sexual dysfunction," or "wellbeing," or "QoL," or "urinary or fecal incontinence."

RESULTS

Although around 1/3 of women aged 50 to 70 years report lack of sexual desire, sexual function problems after treatment for rectal cancer are in the order of 60% among women. QoL improves with length of survival. Urinary and fecal incontinence are ongoing concerns for many women after treatment with rates up to 60%.

CONCLUSION

There is a gap in our knowledge of the effects of rectal cancer and its treatment on urinary and fecal continence, sexual function and QoL in women. There is a need for studies of sufficient size and duration to gain a better understanding of the disease and its management and the long-term effects on these parameters. This information is needed to develop preventative health care plans for women treated for rectal cancer that target those most at risk for these adverse outcomes.

Most colorectal cancer survivors live a large proportion of their remaining life in good health

PURPOSE

Colorectal cancer (CRC) diagnosis reduces life expectancy and decreases patients' well-being. We sought to assess the determinants of health and functional status and estimate the proportion of remaining life that CRC survivors would spend in good health.

METHODS

Using Sullivan method, healthy life expectancy was calculated based on survival data of 14,849 CRC survivors within a population-based cancer registry in southern Netherlands and quality of life information among a random sample of these survivors (n = 1,291).

RESULTS

Overall, albeit short life expectancy (LE at age 50 = 12 years for males and 13 years for females), most CRC survivors spent a large proportion of their remaining life in good health (74 and 77 %, for males and females, respectively). Long-term survivors may expect to live a normal life span (LE at age 50 = 30 years) and spent a large proportion of the remaining life in good health (78 %). In distinction, those with stage IV CRC had less than 2 years to live and spent more than half of their remaining life in poor health.

CONCLUSIONS

Most CRC patients may expect no compromise on living a healthy life, underlining the importance of early detection. On the other hand, the high proportion of non-healthy years among stage IV CRC survivors confirms the importance of early detection and palliative care.

Personality variables as predictors of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life: a one-year prospective study

OBJECTIVE

We aimed to assess the course of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life (HRQOL) and to identify relevant clinical and psychological predictors during a one-year period.

METHODS

Of the 144 early non-metastatic colorectal cancer patients initially assessed for psychological distress symptoms (SCL-90-R), HRQOL (WHOQOL-BREF), sense of coherence (SOC), defense mechanisms (LSI) and hostility (HDHQ), 84 (58.3%) completed the one-year follow-up. Mean (SD) age was 65.1 (9.8) years and 67.4% were male. Mean (SD) disease duration was 1.7 (2.2) years, with 49.3% being diagnosed within the last six months. In 75.0% the site was at colon and in 25.0% at rectum; 2.1% had stage I, 59.0% stage II and 38.9% stage III disease.

RESULTS

Paranoid ideation, psychoticism, interpersonal sensitivity, anxiety and depressive symptoms increased significantly over the one-year period of the study and most of the HRQOL components were significantly decreased over the same period. Men were at greater risk for further developing depressive symptomatology. Low SOC was independent predictor of depression, while hostility independently predicted anxiety, interpersonal sensitivity and psychoticism symptoms. General psychological distress and low SOC were independent predictors of HRQOL, while repression was also an independent predictor of Physical HRQOL.

CONCLUSIONS

In early non-metastatic colorectal cancer patients, psychological distress symptoms are increased and HRQOL is decreased over one-year period. Symptoms of psychological distress are strong predictors of HRQOL, while personality variables can also predict psychological distress symptoms' increase and HRQOL decrease over time, and this could be relevant to psychological interventions.

Exploring the quality of life and the impact of the disease among patients with colorectal cancer: A systematic review

EXECUTIVE SUMMARY

Background: Colorectal cancer has emerged as the most common cancer in Singapore. The quality of life has become increasing important in measuring the outcomes of colorectal cancer patients and the impact of the disease on a person's life.

OBJECTIVES

The objective of this review was to synthesize the best available evidence on the factors that have an impact on the Quality of Life of patients with colorectal cancer.

SEARCH STRATEGY

All primary quantitative studies published in English were considered for inclusion in the review. An extensive electronic database search was conducted since database inception to the December 2010 to identify potential relevant studies using CINAHL, PUBMED/MEDLINE, PsycINFO (OVID, Scopus, ScienceDirect, Springerlink, Web of Science (Social Science Citation Index), Expanded Academic ASAP, Mosby's Nursing Consult, Sociological Abstracts, Mednar and Proquest.

METHODOLOGICAL QUALITY

Two independent reviewers assessed the eligibility and methodological quality of the papers selected prior to inclusion using the appropriate standardised critical appraisal checklists from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. The two reviewers resolved disagreement by discussion.

DATA EXTRACTION

Quantitative data were extracted from relevant studies using the appropriate standardised data extraction tool. Twenty papers were selected and assessed for relevancy. After further review, fifteen papers that met the level of methodological standard were included in this review. The extracted data included specific details about the interventions, participants' demographics, study methods and any outcomes of significance to the aim of the review.

DATA SYNTHESIS

A meta-analysis was not appropriate due to the heterogeneity of methodology in the included studies, thus the findings were presented in a narrative form.

RESULTS

The review included fifteen studies which consisted of twelve descriptive studies and the other three were case-control studies. The findings indicated that patients with colorectal cancer continue to suffer from depression, distress and bowel related problems such as constipation and diarrhoea which impacted their quality of life. European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire, Core Module (QLQ-C30), European Organisation for Research and Treatment of Cancer (EORTC) Colorectal Cancer-Specific Quality of Life Questionnaire Module (QLQ-CR38) and Short Form 36 were the commonly used instruments to assess QoL in this review and most of the instruments included psychological, physical, social and functional aspects. Younger colorectal cancer patients had poorer quality of life when compared to elderly patients. Colorectal cancer also had a greater impact on quality of life outcomes in women when compared to men.

IMPLICATIONS FOR PRACTICE

The evidence generated from this systematic review will assist in the provision of information to develop effective intervention strategies to enhance quality of life and well-being for patients with colorectal cancer and to alleviate and/or prevent a worsening of the symptoms. A pre and post surgery psychosocial assessment should be part of the routine health examinations for early detection of psychosocial problems in patients with colorectal cancer.

IMPLICATIONS FOR RESEARCH

Future research is needed to explore further the factors that impact the quality of life of patients with colorectal cancer with focus on problems like depression, and bowel symptoms. Psychosocial factors have a great impact on patients' perceived quality of life. There is a need to develop interventions such as psychoeducation and self-management programme to help those newly diagnosed cancer patients and long-term cancer survivors.

Personality variables are associated with colorectal cancer patients' quality of life independent of psychological distress and disease severity

OBJECTIVE

The aim of the present study was to test whether psychological distress and personality variables are independently associated with health-related quality of life (HRQOL) in colorectal cancer patients, after adjusting for age, gender, education and disease severity.

METHODS

In a cross-sectional study of 162 colorectal cancer patients (response rate 65.6%), the following self-report instruments were administered: the Symptom Distress Checklist-90-R, the Sense of Coherence scale, the Life Style Index and the Hostility and Direction of Hostility Questionnaire. The outcome measures were the four components of the WHO Quality of Life Instrument, Short Form. We used hierarchical regressions to determine whether psychological distress mediates the relationship of personality and disease parameters with HRQOL.

RESULTS

The overall proportion of the variance in the four components of HRQOL explained by our regression models ranged from 28.1 to 44.4%. Psychological distress was an independent correlate of HRQOL, associated with physical (p<0005), mental (p<0.05) and social relationships HRQOL (p<0.02). Personality variables were associated with HRQOL independent of psychological distress and disease severity. Sense of coherence and denial defense were positively associated with all aspects of HRQOL independent of psychological distress and disease parameters (p-values ranging from p<0.05 to p<0.0005). Hostility (p<0.01) and repression defense (p=0.024) were also independently but negatively associated with physical HRQOL.

CONCLUSIONS

In colorectal cancer patients, psychological distress is associated with HRQOL independent of disease parameters but personality variables are also associated with HRQOL independent of disease severity and psychological distress, and this could be relevant to psychological interventions.

Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning

PURPOSE

Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model.

METHODS

Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis, M=19). Participants completed measures of SpWB (functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp)) and HRQL (functional assessment of cancer therapy-colorectal) in both studies. Measures of general distress (profile of mood states-short form) and cancer-specific distress were also completed in study 1 and study 2, respectively.

RESULTS

After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace.

CONCLUSIONS

This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.

Predictors of health-related quality of life in patients with colorectal cancer

Background

Most studies that have identified variables associated with the health-related quality of life (HRQL) of patients with colorectal cancer have been cross-sectional or included patients with other diagnoses. The objectives of this study were to identify predictors of HRQL in patients with colorectal cancer and interpret the clinical importance of the results.

Methods

We conducted a population-based longitudinal study of patients identified through three regions of the California Cancer Registry. Surveys were completed by 568 patients approximately 9 and 19 months post-diagnosis. Three HRQL outcomes from the Functional Assessment of Cancer Therapy – Colorectal (FACT-C) were evaluated: social/family well-being (SWB), emotional well-being (EWB) and the Trial Outcome Index (TOI), which is a colorectal cancer-specific summary measure of physical function and well-being. Sociodemographic, cancer/health, and healthcare variables were assessed in multivariable regression models. We computed the difference in predicted HRQL scores corresponding to a large difference in a predictor variable, defined as a 1 standard deviation difference for interval variables or the difference relative to the reference category for nominal variables. The effect of an explanatory variable on HRQL was considered clinically meaningful if the predicted score difference was at least as large as the minimally important difference.

Results

Common predictors of better TOI, SWB and EWB were better general health and factors related to better perceived quality of cancer care. Predictor variables in addition to general health and perceived quality of care were identified only for SWB. Being married/living as married was associated with better SWB, whereas being male or of Hispanic ethnicity was associated with worse SWB. Among the sociodemographic, cancer/health, and healthcare variables evaluated, only Hispanic ethnicity had a clinically meaningful effect on an HRQL outcome.

Conclusion

Our findings, particularly the information on the clinical importance of predictor variables, can help clinicians identify patients who may be at risk for poor future HRQL. Potentially modifiable factors were related to perceived quality of cancer care; thus, future research should evaluate whether improving these factors improves HRQL.

Supporting the carers of individuals affected by colorectal cancer

Colorectal cancer is one of the most common cancers, and many difficulties may be experienced as a direct consequence of the disease and its treatment. These can be alleviated and/or resolved with appropriate care. Much of this care is provided informally by the individual's family and friends, whose care needs may be practical, emotional, financial, spiritual or organizational in nature. Care requirement can, as a consequence, be variable in its responsibilities, regularity and duration, since the individual diagnosed with colorectal cancer may require a wide range of support throughout their cancer journey, or have only a few temporary care needs, depending on their disease, treatment and a multitude of other personal, interpersonal and contextual factors. This highlights the importance of regular and individualized assessment. The caregiver's role is often forgotten and hence the impact it may be having upon their own health and lives gets overlooked. Yet, a carer's ability to manage this role has an important bearing not only on patient experience but also on the level of professional involvement. To perform this role satisfactorily carers need to be prepared, supported and also assessed at key points in the patient's cancer journey. Nurses have a professional obligation to help carers by first preparing them, then maintaining sufficient contact to be able to proactively provide practical support and additional health care as needed. This article focuses on these carers and highlights the scope, associated challenges and possible consequences of the caring role. It also seeks to stimulate reflection of how current service provision for carers might be improved.

Methodological issues related to assessing and measuring quality of life in patients with cancer: implications for patient care

Consideration of quality-of-life issues by all members of the healthcare team is essential in caring for people with cancer. In cancer research, quality of life is generally classified as health-related quality of life or individual quality of life. This paper discusses the instruments used to measure quality-of-life outcomes, and the relevance of such findings for healthcare staff in planning and providing effective and patient-centred care. Visual analogue scales (VASs) and questionnaires are commonly used to measure quality of life; however, both types of instruments are criticized because the content may not be relevant to individual patients, and do not distinguish differences between statistical and clinical significances in the findings. Using a combination of questionnaires and VASs may overcome some of these criticisms. In order to interpret the difference between statistical and clinical significance of findings and the associated implications for patient care, a mixed-methods approach to data collection is recommended in quality-of-life studies. This provides meaning and understanding to the quantitative data and individual perspectives on patients' experiences of having cancer. Information from such studies may also be more effective in helping healthcare staff identify relevant issues when planning cancer care services at individual, local and national level.

Stress, self-efficacy and quality of life in cancer patients

The purpose of the study was to examine the effect of different stressors on various domains of quality of life (QOL) in cancer patients. The study focused on testing a model describing interrelations between two kinds of stress antecedents, two mediating variables--perceived stress and self-efficacy--and QOL. The participants were 60 cancer patients of both genders and various diagnoses. They were administered questionnaires of background information, QOL, perceived stress and general self-efficacy. Two stress indices were defined empirically: health stress (based on advanced disease stage, long disease duration, and undergoing treatment) and social stress (based on unemployment, recent immigration, and older age). Confirmatory factor analysis enabled defining five factors of QOL. Hierarchical regression analyses showed that the index of social stress was related to more QOL scales than the index of health stress and very few interactions with the mediating variables. Structural equation modeling provided a more comprehensive and accurate view. It showed that the index of health stress affected QOL mainly through perceived stress, and that self-efficacy affected QOL by reducing perceived stress and increasing QOL. The major conclusions are that QOL is affected negatively by both health stresses and social stresses, but the former are mediated primarily by the experience of perceived stress.

Dimensions of quality of life and psychosocial variables most salient to colorectal cancer patients

Colorectal cancer is one of the most common invasive cancers, and is responsible for considerable physical and psychosocial morbidity. Understanding the quality of life experienced by colorectal cancer patients is essential for evaluating the full impact of the disease on individuals, their families and their communities. Patient perspective is essential in establishing a proper understanding of the quality of life of colorectal cancer patients. Despite this, few studies have employed a qualitative methodology to explore quality of life issues for colorectal cancer patients. A review of the literature identified only seven qualitative studies pertaining to quality of life issues for colorectal cancer patients, a surprising finding given the prevalence of this cancer. Accordingly, this study sought to build on the findings of previous qualitative research by providing descriptive data on the quality of life and psychosocial variables most salient to colorectal cancer patients. Six core themes emerged from interview and focus group data: Satisfaction with diagnosis and treatment; support (including information provision); quality of life; benefits of diagnosis; making sense of the cancer experience; and coping strategies. The information derived from this study will help inform the development of supportive care services to address the needs of the increasing number of people diagnosed with colorectal cancer.